vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2021-1-101-111vtio-1321Research ArticleСмежные дисциплиныRelated DisciplinesПовторные вмешательства после операции Росса: причины, технические подходы, непосредственные результатыRe-interventions after the Ross procedure: reasons, technical approaches, immediate outcomesМуратовР. М.MuratovR. M.

121552, Москва, Рублевское ш., 135.

135, Rubliovskoe sh., Moskva, 121552.

ФедосейкинаМ. И.FedoseykinaM. I.

Федосейкина Мария Ильинична.

121552, Москва, Рублевское ш., 135.

Тел. (977) 387-50-55

Maria Fedoseykina.

135, Rubliovskoe sh., Moskva, 121552.

Phone: (977) 387-50-55

maryilinishna@yandex.ruТитовД. А.TitovD. A.

121552, Москва, Рублевское ш., 135.

135, Rubliovskoe sh., Moskva, 121552.

БритиковД. В.BritikovD. V.

121552, Москва, Рублевское ш., 135.

135, Rubliovskoe sh., Moskva, 121552.

ХугаевГ. А.KhugaevG. A.

121552, Москва, Рублевское ш., 135.

135, Rubliovskoe sh., Moskva, 121552.

Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А.Н. Бакулева Минздрава РоссииРоссияBakulev National Medical Research Center for Cardiovascular SurgeryRussian Federation202110042021231101111Copyright © Муратов Р.М., Федосейкина М.И., Титов Д.А., Бритиков Д.В., Хугаев Г.А., 20212021Муратов Р.М., Федосейкина М.И., Титов Д.А., Бритиков Д.В., Хугаев Г.А.Muratov R.M., Fedoseykina M.I., Titov D.A., Britikov D.V., Khugaev G.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1321

Введение. Повторные операции после протезирования аортального клапана легочным аутографтом (операция Росса) могут быть связаны с дисфункцией неоаортального, неолегочного или обоих оперированных клапанов. Поздняя дисфункция, кроме инфекционного эндокардита, связана с исходной патологией, техническими ошибками и неподходящими материалами для замещения легочного ствола. Повторные операции технически сложны, а тактические подходы окончательно не сформулированы. Цель: анализ повторных вмешательств у больных после операции Росса, технические подходы и непосредственные результаты. Материал и методы. В период 2001-2019 гг. реоперированы 14 пациентов в сроки от 2 дней до 21 года после первичной операции Росса. Показанием к реоперации в раннем послеоперационном периоде явились ранний протезный эндокардит (2) и технические ошибки (1). Причинами реопераций в позднем периоде явились недостаточность неоаортального клапана (7), в том числе - с дисфункцией легочного клапана (2), дегенерация легочного клапана (2), протезный эндокардит клапана легочной артерии (1), эндокардит аортального, легочного и митрального клапанов (1). В соответствии с объемом поражения выполнены: репротезирование аортального клапана (3), репротезирование восходящей аорты (6), в том числе с заменой клапана/ствола легочной артерии (8), стентирование легочного ствола (2). Результаты. Госпитальная летальность составила 7,1%. Один пациент умер от раннего эндокардита после первичной операции. Остальные пациенты перенесли неосложненный послеоперационный период. Микроскопическое исследование неоаорты выявило фрагментацию эластических волокон и перестройку гистоархитектоники ткани. В легочной позиции аортальный аллографт и бескаркасный ксенографт имели тяжелый кальциноз и стенозирование клапана. Выводы. Причинами повторных вмешательств после операции Росса могут быть дисфункция (недостаточность) неоаортального клапана, связанная с пролапсом створок и дилатацией корня аорты. Второй причиной реопераций является дисфункция клапанного трансплантата в позиции легочного ствола. Плановые повторные операции на неоаортальном корне и/или легочном трансплантате, несмотря на большой объем, могут выполняться с низкой летальностью и частотой осложнений. Имплантация аортальных аллографтов и ксенографтов для реконструкции ВОПЖ неоправданна по причине развития их более ранней и тяжелой дисфункции по сравнению с легочным аллографтом.

Re-interventions after pulmonary autograft aortic valve replacement (Ross procedure) may be associated with dysfunction of the neoaortic, neopulmonary, or both operated valves. Late dysfunction, other than infective endocarditis, is associated with underlying conditions, technical errors, and unsuitable pulmonary trunk replacement materials. Re-interventions are technically complex, while tactical approaches have not been definitively formulated. Objective: to analyze re-interventions in patients after Ross procedure, technical approaches and immediate outcomes. Material and methods. Between 2001 and 2019, 14 patients were reoperated upon within 2 days to 21 years after primary Ross procedure. Early prosthetic endocarditis (2) and technical errors (1) were the reasons for early postoperative re-intervention. Neoaortic valve insufficiency (7), including pulmonary valve dysfunction (2), pulmonary valve degeneration (2), pulmonary prosthetic valve endocarditis (1), aortic, pulmonary and mitral valve endocarditis (1) were the reasons for late postoperative re-intervention. Based on the lesion volume, neoaortic valve replacement (3), neoaortic root replacement (6), including pulmonary valve/trunk replacement (8), and pulmonary trunk stenting (2) were performed. Results. In-hospital mortality was 7.1%. One patient died of early endocarditis after primary procedure. The postoperative period for the remaining patients was uneventful. Microscopic examination of the neoaorta revealed fragmentation of elastic fibers and rearrangement of tissue histoarchitectonics. In the pulmonary position, the aortic allograft and stentless xenograft had severe calcification and valve stenosis. Conclusions. Neoaortic valve insufficiency associated with cusp prolapse and neoaortic root dilatation may be the reasons for re-interventions after the Ross procedure. The second reason for re-interventions is valve graft dysfunction in the pulmonary trunk position. Elective reoperations on the neoaortic root and/or lung graft, despite the large volume, can be performed with low mortality and morbidity. Aortic allografts and xenografts for reconstruction of the right ventricular outflow tract (RVOT) is unjustified due to early and more severe dysfunction compared to pulmonary allograft.

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The authors declare that there are no conflicts of interest present.